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Sexual Health Literacy and Sexual and Reproductive Health Knowledge Among Midwives and Nurses in Turkey: Implications for Disaster and Emergency Situations

This cross-sectional study of 360 Turkish midwives and nurses reveals moderate sexual health literacy but low SRH knowledge levels, highlighting that higher education, intensive care experience, and familiarity with disaster protocols significantly improve knowledge and underscoring the need for comprehensive, rights-based training to enhance SRH services during emergencies.

Original authors: Merve Gizem BAGCI, Sevde AKSU

Published 2026-06-29

📖 4 min read☕ Coffee break read

CC BY 4.0

Original authors: Merve Gizem BAGCI, Sevde AKSU

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a hospital as a giant, complex ship. Usually, the crew (nurses and midwives) knows exactly how to steer, cook, and care for passengers. But when a massive storm hits—a disaster like an earthquake—the rules change. The ship is shaking, lights are flickering, and the usual maps might be torn.

This research paper is like a "crew check-up" taken right after a storm simulation in a Turkish hospital. The researchers wanted to know two things about the crew:

Do they know the facts? (Do they know the emergency manual for sexual and reproductive health?)
Are they "literate" enough to use those facts? (Can they understand, judge, and apply that information to help people in a crisis?)

Here is what they found, broken down simply:

1. The "Knowledge Gap" (The Manual vs. The Reality)

Think of Sexual and Reproductive Health (SRH) Knowledge as having a library of emergency manuals.

The Finding: The crew had a decent library, but nearly half of them (46.1%) were missing pages or didn't know how to read the specific chapters needed for a disaster.
The Metaphor: It's like having a fire extinguisher in the hallway but not knowing which pin to pull or when to use it. While they knew general health stuff, they were shaky on the specific "Minimum Initial Service Package" (MISP)—which is basically the "Emergency First-Aid Kit" for sexual health during disasters.

2. The "Literacy" Level (Understanding vs. Just Knowing)

Think of Sexual Health Literacy as the ability to actually use the manual. It's not just reading the words; it's understanding the context, the attitude, and the action.

The Finding: Most of the crew (about 60%) had a "moderate" level of literacy. They could read the manual, but they weren't experts at applying it in the chaos of a storm.
The Twist: There was a difference between the two types of crew members:
- Nurses were better at knowing the facts (the manual content). They had higher scores on the knowledge test.
- Midwives were better at the literacy side (understanding the nuances and attitudes). They scored higher on the literacy test.
- Analogy: Nurses were like the mechanics who knew exactly how the engine worked, while midwives were like the navigators who understood the terrain and the passengers' needs better.

3. What Made the Crew Smarter?

The researchers looked at what made the crew members score higher. It wasn't just about how long they had been working.

Higher Education: Crew members with advanced degrees (like a Master's or PhD) had better knowledge. Think of this as having a more detailed, updated version of the emergency manual.
Intensive Care Experience: Those who worked in the "Intensive Care Unit" (the ship's most critical zone) knew more. They were used to high-stress situations.
Knowing the Plan: The biggest boost in knowledge came from those who actually knew the specific disaster plans (like the MISP and the Turkish Disaster Response Plan). If you know the map, you don't get lost.
Wanting to Learn: Those who asked for more training had higher scores. It's like a student who raises their hand to ask questions; they learn faster.

4. The Connection Between the Two

The study found a strong link between Knowledge and Literacy.

The Metaphor: Imagine knowledge is the fuel in a car, and literacy is the driver's skill. You can't drive well without fuel, but having fuel doesn't mean you can drive safely if you don't know how to steer. The study showed that the more fuel (knowledge) the crew had, the better they could drive (literacy), and vice versa. They go hand-in-hand.

5. The Big Picture Conclusion

The paper concludes that just having a hospital full of doctors and nurses isn't enough to save people during a disaster.

The Takeaway: To protect the most vulnerable people (like women, children, and people with disabilities) during a storm, the crew needs more than just a textbook. They need training that changes their mindset and skills, not just their memory.
The Goal: The researchers suggest that future training programs need to be "inclusive" (making sure everyone is included) and "rights-based" (focusing on human rights), ensuring that when the storm hits, the crew is ready to help everyone, not just the ones who are easiest to reach.

In short: The crew is trying their best, but they are missing some crucial pages in their emergency manuals and need better training on how to use them when the world is shaking. The more they learn and the more they practice, the better they will be at keeping everyone safe.

Technical Summary: Sexual Health Literacy and SRH Knowledge Among Midwives and Nurses in Turkey

Problem Statement
Disasters and extraordinary situations severely disrupt health systems, disproportionately affecting access to Sexual and Reproductive Health (SRH) services. While international frameworks like the Minimum Initial Service Package (MISP) establish standards for crisis response, there is a significant gap in understanding the specific competencies of healthcare providers in these contexts. Existing literature often focuses on structural deficiencies or health outcomes for women, treating provider knowledge and individual competencies as secondary. Furthermore, the relationship between general SRH knowledge and the multidimensional concept of sexual health literacy (the ability to access, understand, evaluate, and apply sexual health information) within disaster settings remains underexplored. This study addresses the lack of quantitative data regarding the SRH knowledge and sexual health literacy levels of midwives and nurses in Turkey during disaster scenarios, particularly concerning vulnerable groups such as persons with disabilities.

Methodology

Design: A descriptive cross-sectional study conducted between January and June 2024.
Setting: A public hospital in Turkey (referred to as "xxxx City Hospital" in the text).
Participants: 360 midwives and nurses were selected via non-probability sampling from a population of 1,200. The sample included 73.6% nurses and 26.4% midwives.
Instruments:
1. Sociodemographic Information Form: Developed by researchers to capture professional and personal characteristics.
2. Sexual and Reproductive Health Knowledge Scale in Extraordinary Situations (23 items): Developed by Ekrem and Kurt (2023), measuring four subdimensions: Empowerment of Women's Health, Supply of Materials for MISP, Basic Knowledge of MISP, and Strategy/Training for MISP. (Cronbach's $\alpha$ = 0.94).
3. Sexual Health Literacy Scale (SHLS) (17 items): Developed by Üstgörül (2022), measuring Sexual Knowledge and Sexual Attitudes. (Cronbach's $\alpha$ = 0.84).
Analysis: Data were analyzed using SPSS version 25.0. Descriptive statistics, independent samples t-tests, one-way ANOVA with Bonferroni post hoc tests, and Pearson correlation analysis were employed. Statistical significance was set at $p < 0.05$ .

Key Results

Knowledge Levels: The mean total SRH knowledge score was 94.57 ± 12.17. Notably, 46.1% of participants were classified as having a low level of SRH knowledge in extraordinary situations.
Literacy Levels: The mean sexual health literacy score was 53.70 ± 8.59, with 59.7% of participants demonstrating a moderate level of literacy.
Professional Differences:
- Nurses scored significantly higher on total SRH knowledge and the "Empowerment of Women's Health" subdimension compared to midwives.
- Midwives scored significantly higher on total sexual health literacy and the "Sexual Knowledge" subdimension.
Influencing Factors: Higher SRH knowledge scores were significantly associated with:
- Postgraduate education levels.
- Working in Intensive Care Units (ICU).
- Having knowledge of the Minimum Initial Service Package (MISP).
- Familiarity with the Turkish Disaster Response Plan (TDRP).
- Expressing a desire for in-service SRH training.
Correlations: Strong, positive correlations were found between sexual health literacy and SRH knowledge levels. Specifically, the "Empowerment of Women's Health" subdimension showed a very strong correlation with total SRH knowledge ( $r = 0.898$ ). However, a significant negative correlation was observed between the "Sexual Attitudes" subdimension and "Empowerment of Women's Health" ( $r = -0.737$ ), suggesting that knowledge does not always translate linearly into attitudes.

Key Contributions
The study provides empirical evidence distinguishing between SRH knowledge and sexual health literacy among healthcare professionals in disaster contexts. It highlights that while professionals may possess moderate literacy, a substantial portion lacks the specific operational knowledge required for disaster response (e.g., MISP implementation). The research identifies specific demographic and professional predictors (education, ICU experience, MISP awareness) that correlate with better preparedness. Additionally, it underscores the divergence between knowledge and attitudes, indicating that educational interventions must address both cognitive and behavioral dimensions to be effective.

Significance and Claims
The authors claim that the effectiveness of SRH services in disaster and emergency situations depends not only on the quantity of knowledge possessed by healthcare professionals but also on the multidimensional nature of sexual health literacy. The findings suggest that current education strategies relying solely on information transfer are insufficient.

The paper emphasizes the need for:

Comprehensive, inclusive, and rights-based training programs that integrate knowledge, attitudes, and practical skills.
Strengthening SRH services for vulnerable groups, specifically persons with disabilities, by addressing the gap between conceptual awareness and operational application.
Policy and training improvements regarding the Minimum Initial Service Package (MISP) and national disaster response plans to ensure that healthcare providers are not only aware of these frameworks but can effectively implement them.

The study concludes that while healthcare professionals have cognitive awareness of sexual health, significant gaps remain in translating this knowledge into practice within disaster contexts, necessitating a shift toward more applied and interdisciplinary educational approaches.